Second allogeneic transplantation after failure of first autologous transplantation

We evaluated the outcome of second allogeneic bone marrow transplantations (BMTs) in 59 patients aged 1-57 years who relapsed after initial autologous transplantation. Patients received a second transplantation for recurrent acute myeloid leukemia (AML) (n = 24), acute lymphoblastic leukemia (ALL) ( n = 13), lymphoma (n = 18), multiple myeloma (n = 3), or chronic myelogenou s leukemia (n = 1) from an HLA-matched related (n = 14), mismatched related (n = 25), or matched unrelated (n = 20) donor. The probabilities of nonrel apse mortality, relapse, and disease-free survival (DFS) 2 years after the second BMT were 51%, 26%, and 23%, respectively. The 2-year DFS estimates f or AE;IL, ALL, and lymphoma were 46%, 23%, and 0%. Univariate analysis demo nstrated that superior DFS was associated with age less than or equal to 17 years at the time of the second transplantation remission before the secon d transplantation, total-body irradiation-based preparative regimen for the second transplantation, and the diagnosis of AML. These data demonstrate t hat an allogeneic transplantation after a failed autologous transplantation can result in disease-free survivors, especially in the young. The outcome s after a second transplantation for patients aged >17 years and for those with lymphoma were especially grim. These data suggest that pediatric patie nts may be appropriate candidates for a second transplantation. In adults, however, the use of an allogeneic transplantation as salvage therapy after failure of the initial autologous transplantation is generally unsuccessful . Alternative experimental strategies, such as low-dose nonmyeloablative al logeneic minitransplantations should be considered.